How Low Can You Go?
BY KIRSTEN FILL; JAMES MACGREGOR; ANDREW VICTOR; & AHMED RAZIUDDEN, MDA 32-year-old man was found unresponsive at home by his mother who immediately called the paramedics. The patient was in asystole upon their arrival, and CPR/ACLS protocol was started along with intubation. The patient was transported to the hospital, where ACLS protocol was continued and eventually resulted in the return of a stable pulse. The patient had a significant history of alcohol abuse resulting in liver disease, but had no prior episodes of such events. He also was a smoker of tobacco and marijuana. The patient's mother reported that he ...
Source: The Case Files - December 27, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Back Pain Edition: An Unusual Case of Back Pain
BY MARK GRANT, DOA 31-year-old man presented to the emergency department with dyspnea, fever, cough, and weakness for two weeks. He had recently seen his internist, and was diagnosed with a viral infection. He was seen again at an urgent care center a few days before his ED presentation, and was diagnosed with bronchitis and an ear infection and placed on an antibiotic.The patient said in the ED that he was not improving, and was now experiencing back pain, shortness of breath, and occasional fevers and sweats. The patient stated he had sharp chest pain at times and was coughing up clear sputum more often over t...
Source: The Case Files - September 13, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Back Pain Edition: A Mysterious Case of Back Pain
BY SEFAKO PHALA; ROBERT STATZ; ANDREW VICTOR; MOHAMMED HASSAN-ALI, MD, MSC; & AHMED RAZIUDDIN, MDA 65-year-old Caucasian man was brought to the ED via ambulance complaining of worsening upper back pain for one week. His primary care physician had recently prescribed him NSAIDs and muscle relaxants, which failed to provide relief. The newest symptoms were numbness and weakness over his left arm and leg. The patient reported no history of trauma to his back nor did he have any chronic illnesses. Physical exam showed paresthesia in the left upper extremity in a dermatomal distribution pattern that suggested ...
Source: The Case Files - September 13, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Rare and Unexpected Cause of Headache in the ED
BY MEGHAN JONES, MD; ANN HAYNES, MD; & ANDREW KING, MDWhen patients present to the emergency department complaining of headache, the emergency physician must consider a large list of differential diagnoses. Emergency physicians often hope patients will fall into pre-existing, well-known patterns, helping them to establish the appropriate workup quickly. Despite common illness scripts and presentations, many patients will present unusually and lead physicians to findings they were not expecting.A 54-year-old woman with a history of hepatitis C presented to the emergency department for a headache that...
Source: The Case Files - August 23, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
The Case of the Painful Blisters
BY JOHN DAVIS, MD; & RYAN THOMPSON, MDAn 89-year-old woman presented to the emergency department with three days of painful swallowing and oral blisters. She first noticed intraoral blisters two days before presentation, with blisters on the upper lip occurring the following day. She was only able to swallow small amounts of liquids. Intraoral lesions on left half of the hard and soft palates without extension across the midline.Her exam revealed multiple vesicular lesions on the left upper lip and nares and multiple vesicular lesions extending from the midline of the hard and soft palates late...
Source: The Case Files - June 28, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
How Many Physicians Does It Take to Perform a Cricothyrotomy?
BY ALICE S. Y. LEE, MDEmergency physicians usually respond to in-house cardiopulmonary arrests, and each case is somewhat the same. You arrive at the bedside with no information about the patient, and must quickly assess the situation via a combination of nurse report and a focused patient exam. Securing an airway in cardiopulmonary arrest is critical to the resuscitation, and the EP should be the most skilled at this task.This was put to the test in our hospital recently. A 70-year-old, 54 kg woman with a history of end-stage renal disease (ESRD) had been admitted to our hospital with marked hyperkalemia. She had...
Source: The Case Files - June 14, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Chest Pain, Dyspnea, and Diaphoresis
BY BENJAMIN COOPER, MDA 38-year-old man with a history of hypertension and a heart defect status post-repair in infancy presented with acute onset chest pain, dyspnea, and diaphoresis. He had a similar episode at another hospital one month prior that resolved after “some medication.” He denies drug use.The patient's blood pressure was 120/70 mm Hg. He was alert and oriented, and although dyspneic, was speaking in full sentences. His respiratory rate was in the lower 20s, and oxygen saturation was 98 percent on room air. An ECG was obtained in triage, and is shown. His diagnosis? Stable ventricular tachycardi...
Source: The Case Files - April 26, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Patient with URI and Lobe Lesion on Chest X-Ray
BY MARGARET MARY S. LANDEL, DO; & CARLA DUGAS, DOA 59-year-old otherwise healthy man presented with an upper respiratory illness of four weeks' duration. His initial presentation to his primary care physician one month prior included a nonproductive cough and low-grade fever, which lasted approximately two weeks until his internist ordered a chest x-ray. That showed a 3 cm well-circumscribed right lower lobe lesion, and was followed by a contrast enhanced chest CT. The chest CT was concerning for pulmonary neoplasm, and he received an interventional radiology-guided biopsy of the lesion. Results were still pending a...
Source: The Case Files - April 12, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: research
